Denial Code CO 23

Denial Code CO 23 – Primary paid more than secondary allowance

It means primary insurance allowed amount is more than secondary insurance allowable amount. Usually, secondary insurance denies with denial code CO 23 – Primary paid more than secondary allowance indicating primary insurance already processed and allowed the claim which is more than their allowance and this claim is not payable as per their fee schedule.

Explaining denial with an example:

Let’s consider Patient name Chris is insured with Medicare as primary and Medicaid as secondary

Provider has billed the claim to primary Medicare insurance with billed amount $300 for the services rendered to patient.

Primary Medicare insurance processed the claim and allowed $250 and paid $200 with coinsurance $50, so here the contractual adjustment is $50.

Now claim has been forwarded to secondary Medicaid along with primary EOB Medicare for the balance amount $50.

But secondary Medicaid processed the claim and allowed $180 as per their fee schedule and denied the claim with denial code CO 23 – Primary paid more than secondary allowance.

Steps to follow for denial code CO 23 resolution:

Get the claim denial date?

First step is to check the secondary insurance allowed amount as per fee schedule?

Then next step is verifying the primary insurance allowed amount, paid and patient responsibility?

If suppose primary paid is not more than secondary allowance and found denial is invalid, then inform the representative and sent the claim back for reprocessing

If primary paid is more than secondary insurance is valid, then get the claim number and call reference number.

Note: If the primary paid more than secondary allowance denial is valid, then usually will write off the charges.

Collection notes:

As per review found claim was primary Medicare processed and paid $200 with coinsurance $50 and found claim forwarded to secondary Medicaid insurance. Cld Medicaid insurance and found claim was denied on xx-xx-xxxx as primary paid more than secondary allowance. Secondary Medicaid allowed amount is $180 and found primary paid $200, therefore adjusted the balance as primary paid more than secondary allowance. Claim# 123456789, Cal reference# 234732948.

Frequently asked question:

Consider primary insurance allowed 100 percent and processed towards patient responsibility as out of pocket expense and claim forwarded to secondary Medicaid insurance. Secondary Medicaid allowed 50 percent of the billed amount as per their fee schedule and denied the claim with denial code CO 23?

In this case, we will not bill balance to patient as secondary insurance is Medicaid and we should not bill the balance to Medicaid patients.

Medical Billing Denials and actions – Top Denial codes Solutions (medicalbillingcycle.com)